{"title":"Management of pre-gestational diabetes in pregnancy","authors":"","doi":"10.1016/j.mpmed.2024.07.007","DOIUrl":null,"url":null,"abstract":"<div><div>Pre-gestational diabetes – type 1 and type 2 diabetes mellitus – affects 1.7% of all pregnancies in the UK, and 1.3% of all pregnancies worldwide. In the UK there are now more pregnancies in women with type 2 than type 1 diabetes mellitus. Pre-gestational diabetes is associated with increased maternal and fetal risk including congenital abnormalities, stillbirth and pre-eclampsia; diabetic ketoacidosis also affects >1% of pregnancies. There are three targets for pre-pregnancy to reduce complications: glycated haemoglobin <48 mmol/mol (6.5%); folic acid 5 mg for at least 1 month before pregnancy; and avoidance of all teratogenic drugs. In pregnancy, tight glycaemic control is recommended, with a target blood glucose range of 3.5–7.8 mmol/litre. Increased doses of insulin are required through the course of pregnancy because of increasing insulin resistance. Childbirth is generally recommended in all those with pre-gestational diabetes between 37 and 38<sup>+6</sup> weeks because of the risk of stillbirth and other complications. Continuous glucose monitoring and hybrid closed-loop insulin delivery systems have been shown to improve pregnancy outcomes in type 1 diabetes.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicine (Abingdon, England : UK ed.)","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1357303924001786","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Pre-gestational diabetes – type 1 and type 2 diabetes mellitus – affects 1.7% of all pregnancies in the UK, and 1.3% of all pregnancies worldwide. In the UK there are now more pregnancies in women with type 2 than type 1 diabetes mellitus. Pre-gestational diabetes is associated with increased maternal and fetal risk including congenital abnormalities, stillbirth and pre-eclampsia; diabetic ketoacidosis also affects >1% of pregnancies. There are three targets for pre-pregnancy to reduce complications: glycated haemoglobin <48 mmol/mol (6.5%); folic acid 5 mg for at least 1 month before pregnancy; and avoidance of all teratogenic drugs. In pregnancy, tight glycaemic control is recommended, with a target blood glucose range of 3.5–7.8 mmol/litre. Increased doses of insulin are required through the course of pregnancy because of increasing insulin resistance. Childbirth is generally recommended in all those with pre-gestational diabetes between 37 and 38+6 weeks because of the risk of stillbirth and other complications. Continuous glucose monitoring and hybrid closed-loop insulin delivery systems have been shown to improve pregnancy outcomes in type 1 diabetes.